Background: Hypertension is an increasing public health concern in Uganda, with social determinants potentially playing a crucial role in its distribution. This study aimed to examine the relationship between socioeconomic status (SES) and hypertension among Ugandan adults, investigate potential mediating effects of lifestyle factors, and assess the moderating role of healthcare access. Methods: A cross-sectional study was conducted among 400 adults aged 18 years and above, selected through stratified random sampling from urban and rural areas in Uganda. Data were collected using structured questionnaires and blood pressure measurements. Binary logistic regression was employed to examine associations between SES indicators (education, income, employment) and hypertension, while mediation and moderation analyses were conducted to investigate pathways and effect modifications. Results: The prevalence of hypertension was 33% in the study population. Higher education level was significantly associated with lower odds of hypertension, with tertiary education conferring the strongest protective effect (AOR=0.41, 95% CI: 0.18-0.92, p=0.031). Higher income showed a protective trend, though this was attenuated after adjustment for confounders. Lifestyle factors significantly mediated the SES- hypertension relationship, with dietary patterns accounting for approximately 31% of the effect, physical activity 25%, and stress levels 14%. Healthcare access significantly moderated the protective effect of higher SES, with the combination of tertiary education and good healthcare access associated with 72% lower odds of hypertension (AOR=0.28, 95% CI: 0.11-0.73, p=0.009) compared to no formal education with poor access. Conclusion: Socioeconomic disparities significantly influenced hypertension prevalence among Ugandan adults, with education showing the strongest protective effect. These disparities were partially mediated by lifestyle factors and enhanced by healthcare access. Comprehensive interventions addressing both